Facility Evaluation Report

Licensing Program Analysts (LPA) Elizabeth Irra and Tena Herrera conducted an unannounced annual inspection. LPAs were allowed by Kip Dukes. LPAs explained the purpose of today's visit.

There are (4) clients residing at this home. This single story home consists of (3) bedrooms, 2 bathrooms, living room, kitchen, dinning area and attached garage. All clients receive case management services provided by San Gabriel Pomona Regional Center.

COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility and throughout the facility.

Signs are posted to promote hand washing, cough/sneeze etiquette, and physical distancing were observed.

PPE supplies observed. Hand sanitizers observed throughout the common areas.

Restrooms have hand soap, hand sanitizer and paper towels.

Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Additional food supply observed inside the garage.

Water supply observed (including emergency water supply).

Per Administrator, all (4) clients are fully vaccinated and have their booster.

Per Administrator, all staff are fully vaccinated and have their booster.

Medication reviewed for (4) Clients (Client #1 through Client #4).

Staff responsible for direct care and supervision will wear masks.

Clients were being socially distanced according to local public health guidelines.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Kip Dukes.